Diarrhoea

Question 1

Symptoms of diarrhoea

Answer 1

• Frequent, loose, watery stools

- Abdo cramps, nausea, flatulence, dehydration

Question 2

When to refer diarrhoea?

Answer 2

• Babies < 3 months - immediately
• Babies < 1 year, diabetic, elderly - 1+ days
• < 3 years - 2+ days
• Refer everyone over 3 days

Signs of dehydration (Dry skin, sunken eyes, dry tongue, drowsiness/lightheaded, less urine/dark urine, depressed fontanelle in babies)

Alarm symptoms (Blood/mucus in stool - Gastric bleeding, bowel cancer, IBD?) (Long standing change in bowel habit in 50+ years, weightloss - colorectal cancer?)
(Suspected faecal impaction in elderly)

Other (Sever vomiting, high fever) (Recent travel abroad - Giardiasis)

Chronic diarrhoea 3 weeks + (IBS, crohns, Ulcerative colitis, coeliacs, diverticular)

Question 3

Which meds cause referral with diarrhoea?

Answer 3

Magnesium antacids (laxating)
NSAIDS
IRON
LAXATIVeS
Antibiotics (colitis)
Digoxin (sign of toxicity)
PPI
diuretics
SSRI (GI effects)

Question 4

OTC for diarrhoea - 1st line + 1st drug (age)

How work, dose, how take, max dose, warnings

Answer 4

1st line:
- Oral rehydration therapy all ages

• Replaces lost fluid and electrolytes
• 1-2 sachets after each loose motion
• Dissolve in WATER. For babies : boiled + cooled.
• Make just before use, stored in fridge for 24 hours

1st? Drug:

• Loperamide 12+ (Imodium)
• Anti-motility drug binds to opioid receptors in gut to slow perstalsis
• 2 caps after each loose stool - MAX 8 a day
• Not rec for pregnancy OR breastfeeding

Question 5

Details on Kaolin + Morphine. CD class and age.

Answer 5

For diarrhoea less recommended.

12+ CD5

Question 6

Details on Bismuth salicyclate (pepto-bismol)

Answer 6

Less recommended for diarrhoea
16+
Avoid in aspiring sensitivity, causes black stools and tongue
(Antacid)

Question 7

Advice for diarrhoea? BAbies?

Answer 7

• Stay hydrated (Drink plenty water)
• Eat plain bland foods
• Babies - dilute formula to quarter strength and build back to normal over 3 days, feed mor frequently than normal and supplement with oral rehydration therapy to prevent dehydration
• avoid high sugar drinks
• avoid milk
• travelling abroad - drink bottled water, avoid uncooked meat, wash hands reg